Thorax Flashcards
What structures lie at the level of the sternal angle?
2nd rib T4 Vertebra great vessels of the heart (PA bifurcation) trachea bifurcation azygous vein drains into SVC
what is the jugular notch also known as?
suprasternal notch of manubrium
Osteology: what are the atypical features of 1st rib?
1 articular facet on head (articulates with T1)
scalene tubercle (anterior scalene attaches)
subclavian artery and vein grooves (Vein anterior to scalene tubercle, artery posterior)
most curved and flat rib
Osteology:
What are the features of a typical rib?
head (with 2 articular facets - aka demi-facets), neck, tubercle (for costo-transverse joint) and body
Osteology: which ribs are typical ribs?
3-9
Osteology: what is a true rib?
articulates directly with its own costal cartilage and the sternum (ribs 1-7)
Osteology: what is a false rib and which ribs are false?
doesn’t have its own costal cartilage that articulates directly with the sternum but does articulate with costal cartilage
ribs 8, 9 and 10
Osteology:
what is a floating rib?
ribs 11 and 12 - only articulate with the vertebra
Osteology:
What ribs are atypical?
1, 2, 10, 11 and 12
Osteology:
What are the atypical features of rib 2?
tuberosity for serratus anterior attachment
Osteology: what are the atypical features of rib 10?
one articular facet joint (costo-vertebral joint)
Osteology: What are the atypical features of ribs 11 and 12?
one articular facet on head (costovertebral joint) - articulates only T11/T12 respectively
no neck or tubercle (there is no costotransverse joint here)
both floating ribs
Osteology:
What does the clavicle articulate with?
manubrium and acromion
Osteology:
what attaches the clavicle to the coronoid process?
ligaments
Osteology:
what vertebra is this?
T6 - note heart shaped vertebral body small vetebral foramina demi-facets costal facets on Transverse processes Inferior slanting spinous process
Osteology:
where would you find this vertebra?
lumbar
- big kidney bean shaped vertebral body
- short and straight spinous process (does not slant like thoracic does)
- intervetebral articular facets angled medially (allows for movement in lumbar spine)
- no articulations with transverse processes (no costal facets like in T6 for example)
Osteology:
compare the cervical vertebra with the lumbar
cervical -
- wide vetebral foramen
- small vetebral body
- transverse foramina
- bifid spinous process
- intervetebral facet joints slant inferiorly
both have short spinous process generally which don’t extend inferiorly
lumbar -
- facet joints slant inferior-medially
- long transverse processes
Osteology:
which rib is this?
typical rib - 5
Osteology:
Name the following ribs:
Osteology:
what rib does T10 articulate with ?
10
what vertebra does rib 2 articulate with?
T1 and 2
what vertebra does rib 8 articulate with?
T7 and 8
where does the pleura of the lungs extend to inferiorly?
T12 in midline posteriorly, rib 10 in posterior axillary line, rib 9 anteriorly
where do the lungs extend to inferiorly?
T10 posterior midline
8th rib mid axillary line
rib 6 mid clavicular line (just below the level of the xiphisternum)
where does the oblique fissure run?
T4 posteriorly
crosses 5th intercostal space in mid-axillary line
6th rib anteriorly in mid-clavicular line
where is the horizontal fissure?
right lung
runs from 4th costal cartilage anteriorly to the 5th intercostal space in the mid axillary line (where it meets the oblique fissure)
describe in terms of surface anatomy the location of the borders of the heart
superior right atrium - 2nd IC space 1cm lateral to body of sternum
inferior right atrium - 5th intercostal space 1cm lateral to body of sternum
superior left atrium - 2nd IC space 2,3 cm lateral to body of sternum
apex - 5th IC space in mid clavicular line
where do the medial and lateral pectoral nerve branch from?
medial and lateral chords of the brachial plexus
what are the nerve roots of the medial and lateral pectoral nerves?
lateral - c5-c7
medial - c8-t1
what do the medial and lateral pectoral nerves supply?
pec major and minor
where can you find the medial pectoral nerve?
penetrating through pec minor near to its attachment to the coracoid process
what structures should you find in the hilum of the lung?
bronchi (most posteriorly theoretically)
pulmonary artery (most superior ish and anterior to bronchi)
pulmonary veins ( most inferior and anterior)
bronchial arteries - very small and around the bronchi
in the bronchial tree - which part has complete rings of cartilage?
main right and left (primary) bronchi
how many lobar (secondary) bronchi are there?
2 on left and 3 on right
what order do the bronchi branch in?
main bronchi, lobar, segmental (then becomes bronchioles)
what is the difference between a bronchi and a bronchiole
size and cartilage (bronchioles do not have cartilage)
why do IFBs often get stuck in the right main bronchus?
complete rings of cartilage and more vertical orientation
what is a bronchopulmonary segment?
segmental bronchi divide the lung up into these segments which are functional units
where does gas exchange occur in the lung?
respiratory bronchioles and alveoli
what are the nerve roots of the phrenic nerve?
C3, 4, 5 keeps the diaphragm alive
where does the phrenic nerve descend?
through middle mediastinum overlying the fibrous pericardium
what is the function of the phrenic nerve?
motor - diaphragm
sensory - diaphragm, pleura of lung, pericardium, IVC and peritoneum
what artery runs with the phrenic nerve?
pericardiophrenic artery
describe the path of the vagus nerve
medulla, jugular foramen, carotid sheath, follows oesophagus through the diaphragm
where can you locate the left vagus nerve in the superior mediastinum ?
posterior to the left brachiocephalic vein
in between the left subclavian and left common carotid artery
where is the left recurrent laryngeal nerve? what does it innervate?
loops under arch of aorta - branch of vagus, innervates the larynx
where is the right recurrent laryngeal nerve?
loops under right subclavian artery then ascends to larynx
what is the function of the vagus nerve?
Sensory: Innervates the skin of the external acoustic meatus and the internal surfaces of the laryngopharynx and larynx. Provides visceral sensation to the heart and abdominal viscera.
Special Sensory: Provides taste sensation to the epiglottis and root of the tongue.
Motor: Provides motor innervation to the majority of the muscles of the pharynx, soft palate and larynx.
Parasympathetic: Innervates the smooth muscle of the trachea, bronchi and gastro-intestinal tract and regulates heart rhythm.
